Our Clinical Services Center offers business process outsourcing for prior authorization requests using our PA Logic™ web based tool for pharmaceutical utilization management.
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Our fraud and abuse management experience allows us to analyze benefit utilization data as a basis to identify patterns of use that warrant further investigation. Specifically, our Recipient Restriction System uses pharmacy and medical claims to identify members abuse within the health benefit and suggest restriction programs around pharmacy and medical providers.
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Our Pharmaceutical Care Management program offers a medication therapy management service to identify members who many benefit from ongoing intervention programs.
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Our analytics arm is experienced in analyzing and reporting from pharmacy, lab, and medical claims data to suggest and measure impact of interventions on behalf of our clients.
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